The program, which involves an agreement between Tom Green County and local health care providers, is funded by county, state and federal money.

For every dollar the county sends to the Texas Health and Human Services Commission, it receives a match of about $2.30. Having set aside $1 million in the current budget year, that would mean a $2.3 million match.

Indigent funding is split between San Angelo’s two hospital systems, with 94 percent toward Shannon Medical Center and 6 percent toward San Angelo Community Medical Center.

However, Shannon officials said the hospital system is receiving a larger volume of indigent patients than the allocation should equate to, said Dianna Spieker, county treasurer.

In order to take care of its indigent health population, Spieker said, the county has two options: to send more money to the HHSC to be matched or to be directly billed by the providers.

“Shannon would benefit if they direct-billed us,” Spieker said. “But if we have the opportunity, we should be bringing down federal and state money.”

Sending $500,000 to the HHSC now would allow the current structure of the program to continue through September, the end of the budget year. If the county switched to being directly billed by the providers, Spieker said, it would end up spending about twice as much.

“So we pull out half a million now or pay 1 million later?” said Precinct 4 Commissioner Bill Ford.

Having examined the current budget, Spieker recommended the commissioners approve a line-item transfer of $500,000 from the budget for a remodeling project of the Edd B. Keyes building, as it would not be expended this year.

“I want a full court to make a decision with taxpayers’ money,” said Precinct 3 County Commissioner and County Judge Pro-Tem Steve Floyd. “This is the most major transfer in the middle of the budget year I’ve seen.”

While most commissioners were receptive of Spieker’s recommendation, wanting to do additional research and make a decision when County Judge Mike Brown was back, Precinct 1 Commissioner Ralph Hoelscher was unsure about the transfer.

“My concern is that the money has been borrowed for capital improvements. ... We’re waiting for the final contract,” Hoelscher said. “How are we going to come up with the money to replace that? Does everything with the renovation stop?”

After further discussion, the commissioners unanimously approved the motion to table the final decision for another week.

“We were pleased to hear the recommendation from Ms. Spieker,” said Brian Horner, president and chief executive officer of Shannon. “We will continue to monitor the progress of their decision.”

In response to some comments about switching to a single hospital provider, Eric Becker, chief executive officer for Community, said it would be in the best interest to give patients a choice rather than eliminating one of the city’s big providers.

“We want to be a part of the program. We’re committed to it,” he said. “I want to do what is best for us and what is best for the county’s interests while keeping patient choice as well.”

The county serves roughly 380 clients under its Indigent Health Care Program and is considered a “payer of last resort.” The state requires eligible households to have a monthly income that does not exceed 21 percent of the Federal Poverty Guideline. Those who receive or are eligible for Medicaid are disqualified from the program.

The program covers medical expenses up to $30,000, and clients are approved for six months at a time.

As he said this is probably the largest monetary decision he has seen since he came on board with the county in 2005, Floyd said the commissioners need more time to research and take the recommendations into consideration.

“I don’t think we have a huge sense of urgency to make this decision for us not to do our due diligence for the taxpayers and the indigent patients,” he said. “We need to explore those options to make a good decision and wait till we have a full court to take significant actions.”